Healthcare Provider Details

I. General information

NPI: 1689714628
Provider Name (Legal Business Name): MRS. HEIDI SARMENTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 KANSAS AVE.
SAN LUIS OBISPO CA
93401
US

IV. Provider business mailing address

1303 STONEY CREEK RD
PASO ROBLES CA
93446-5185
US

V. Phone/Fax

Practice location:
  • Phone: 805-784-4614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT31132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: